An Intraoperative Telemedicine Program to Improve Perioperative Quality Measures
Authors: Christopher R. King, Stephen Gregory, Bradley A. Fritz, Thaddeus P. Budelier, Arbi Ben Abdallah, Alex Kronzer, Daniel L. Helsten, Brian Torres, Sherry McKinnon, Shreya Goswami, Divya Mehta, Omokhaye Higo, Paul Kerby, Bernadette Henrichs, Troy S. Wildes, Mary C. Politi, Joanna Abraham, Michael S. Avidan, Thomas Kannampallil, Mohamed Abdelhack, Amrita Aranake-Chrisinger, Aaron Archer, Maureen Arends, Emily Armstrong, Umeshkumar Athiraman, Sennaraj Balasubramanian, Anchal Bansal, Kara Battig, Danielle Benematti, George Benzinger, Mara Bollini, Anuradha Borle, Michael Bottros, Walter Boyle, Thomas Bozada, Margaret Bradley, BrandonUfert BrandonUfert, Christina Brown, Jamie Brown-Shpigel, Jamila Burton, Megan Carmony, Kathryn Cass, Laura Cavallone, Yunwei Chen, Yixin Chen, Han Choi, Marissa Coggin, Zachary Cohen, Casey Critchlow, Christopher Davies, Christopher Davis, Aaron Demler-Barth, Ryan Durk, Daniel Eddins, David Eisenbath, Meredith Ellis, Daniel Emmert, Krisztina Escallier, Jane Exler, Mitchell Fingerman, Ellen Fischbach, Elizabeth Frasca, Michelle Ge, Jason Gillihan, Marie Goez, Natasha Goodwin, Thomas Graetz, Ryan Guffey, Shelly Gupta, Katharine Gurba, Kelsey Gutesa, Tracey Guthrie, Michael Hakim, Charles Hantler, Peter Haw, Hilary Heeger, Erin Herrera, Alex Hincker, Robert Hovis, Gary Hubbard, Rocco Hueneke, Mark Ingram, Zahid Iqbal, Susan Ironstone, Kyle Jacobsen, Nisha Jain, Bassel Kadi, Ivan Kangrga, Menelaos Karanikolas, Bridget Kinealy, Mary Kinworthy, Holly Kirkpatrick, Esad Kiveric, Andrea Knibb, Justin Knittel, Andreas Kokefer, Helga Koman, Joseph Kras, Kristin Kraus, Anand Lakshminarasimhachar, Joseph Larese, Chakrapol Lattanand, Aparna Malshet Casarella, Jonathan Mathew, Hannah Maybrier, Peter McAvity, Alyssa McClellan, Jacob McDowell, Heather McKenzie, Alicia Meng, Angela Mickle, Melissa Milbrandt, Preet Mohinder Singh, Alexander Mohrmann, David Monks, Arianna Montes de Oca, Teresa Murray-Torres, Khatera Najrabi, Lauren Nowakowski, Ifeanyi Nwokeabia, Jordan Oberhaus, Ekua Owusu-Bediako, Daniel Park, Aamil Patel, Sarah Perez, Caroline Phillips, David Potter, Debra Pulley, Govind Rangrass, Janavi Rao, Rashmi Rathor, Isabella Riordan, Cameron Ritter, Evan Roller, Martha Sabino, Matthew Sanzalone, Elvira Sayfutdinova, Craig Schadler, Elizabeth Schappe, Alexandra Schatz, Anne Sebastiani, Kimberly Seiber, Anshuman Sharma, Sarah Sillery, Kate Silver, Susan Siraco, Melanie Somercik, Pratyush Sontha, James Spencer, Erika Spencer, Tracey Stevens, Jasmin Swaniker, Martha Szabo, Raghu Terkonda, Carolyn Thai, Marko Todorovic, Brian Tolly, Emma Trammel, Sandhya Tripathi, Lisa Tseng, Bradley Uding, Ravi Upadhyayula, Swarup Varaday, William Varnum, Minna Wang, Sarah Watkins, Mark Willingham, William Wise, Rachel Wolfe, Maxim Wolfson, Hannah Woodstock, Randy Wright, Katie Yang, Branden Yee, Jennifer Yuan, Paul Zanaboni, Jessica Zenga, James Zhang, Tianyang Zheng, Nicholas Zimick, Joshua Zwingelberg
Journal: JAMA Network Open (2023)

Importance Telemedicine for clinical decision support has been adopted in many health care settings, but its utility in improving intraoperative care has not been assessed. Objective To pilot the implementation of a real-time intraoperative telemedicine decision support program and evaluate whether it reduces postoperative hypothermia and hyperglycemia as well as other quality of care measures. Design, Setting, and Participants This single-center pilot randomized clinical trial (Anesthesiology Control Tower–Feedback Alerts to Supplement Treatments [ACTFAST-3]) was conducted from April 3, 2017, to June 30, 2019, at a large academic medical center in the US. A total of 26 254 adult surgical patients were randomized to receive either usual intraoperative care (control group; n = 12 980) or usual care augmented by telemedicine decision support (intervention group; n = 13 274). Data were initially analyzed from April 22 to May 19, 2021, with updates in November 2022 and February 2023. Intervention Patients received either usual care (medical direction from the anesthesia care team) or intraoperative anesthesia care monitored and augmented by decision support from the Anesthesiology Control Tower (ACT), a real-time, live telemedicine intervention. The ACT incorporated remote monitoring of operating rooms by a team of anesthesia clinicians with customized analysis software. The ACT reviewed alerts and electronic health record data to inform recommendations to operating room clinicians. Main Outcomes and Measures The primary outcomes were avoidance of postoperative hypothermia (defined as the proportion of patients with a final recorded intraoperative core temperature &amp;amp;gt;36 °C) and hyperglycemia (defined as the proportion of patients with diabetes who had a blood glucose level ≤180 mg/dL on arrival to the postanesthesia recovery area). Secondary outcomes included intraoperative hypotension, temperature monitoring, timely antibiotic redosing, intraoperative glucose evaluation and management, neuromuscular blockade documentation, ventilator management, and volatile anesthetic overuse. Results Among 26 254 participants, 13 393 (51.0%) were female and 20 169 (76.8%) were White, with a median (IQR) age of 60 (47-69) years. There was no treatment effect on avoidance of hyperglycemia (7445 of 8676 patients [85.8%] in the intervention group vs 7559 of 8815 [85.8%] in the control group; rate ratio [RR], 1.00; 95% CI, 0.99-1.01) or hypothermia (7602 of 11 447 patients [66.4%] in the intervention group vs 7783 of 11 672 [66.7.%] in the control group; RR, 1.00; 95% CI, 0.97-1.02). Intraoperative glucose measurement was more common among patients with diabetes in the intervention group (RR, 1.07; 95% CI, 1.01-1.15), but other secondary outcomes were not significantly different. Conclusions and Relevance In this randomized clinical trial, anesthesia care quality measures did not differ between groups, with high confidence in the findings. These results suggest that the intervention did not affect the targeted care practices. Further streamlining of clinical decision support and workflows may help the intraoperative telemedicine program achieve improvement in targeted clinical measures. Trial Registration ClinicalTrials.gov Identifier: NCT02830126